a. Employees of the Department of Human Services in their individual capacity at the time of an occurrence covered hereinafter.

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1 1 of 5 1. Background: By virtue of the authority delegated to the Department of Administrative Services (DOAS), a Self Insurance Program to provide Broad Form State Employee Liability Coverage has been developed. This policy, issued by DOAS, is a manuscript policy, meaning it provides one liability coverage which includes General Liability, Medical Malpractice, Legal Liability, Police Officer's Liability, Directors & Officers, Errors and Omissions, Punitive Damages and the reimbursement for legal fees for the successful defense of criminal allegations. 2. Exclusions: Partial List a. Claims insured under the State Tort Claims Liability Policy ("Georgia Tort Claims Act"). b. Activities of any insured not associated with or related to the insured's activities in a position or office in or with the Department of Human Services. c. Property lost or property damage to any property owned or occupied or rented to any insured or property used by any insured, or property in the care, custody or control of any insured. d. Damages resulting from any dishonest, fraudulent or criminal act or omission of any insured for which a criminal prosecution has been successfully made against any insured by verdict or plea of guilty or a plea of nolo contendere. e. Bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of any automobile, or any land motor vehicle licensed for public road use. f. Non-State employees or volunteers except when authorized by state law and only if a premium is paid by a state agency to insure non-state employees or volunteers. 3. Insured: a. Employees of the Department of Human Services in their individual capacity at the time of an occurrence covered hereinafter. b. Board Members designated by DHS in their individual capacity which includes, but is not limited to the Division of Family and Children Services and the Division of Aging Services. c. Elected or appointed members of DHS in their individual capacity.

2 2 of 5 d. Any non-state employee designated by law to be a State employee for insurance purposes only, and only if a premium is paid for such coverage. e. Any participating entity as authorized by O.C.G.A et seq. now enacted or hereafter enacted. f. Foster parents and foster children designated by DHS. 4. Definitions: a. "Personal Injury" shall mean an injury sustained by any person arising out of one or more of the following circumstances: (1) false arrest, detention or imprisonment, abuse of process, or malicious prosecution; (2) publication or utterance of libel or slander or other defamatory or disparaging material, or a publication or utterance in violation of an individual's right of privacy; except publications or utterances in the course of or related to advertising activities conducted by or on behalf of any insured; (3) wrongful entry or eviction, or any other invasion of the right of private occupancy; and (4) any act which gives rise to any liability under any Federal civil rights statute or the Fair Labor Standards Act if such is committed during the policy period. b. "Bodily Injury" means any bodily injury, sickness or disease sustained by a person which occurs during the policy period, including death at any time resulting there from. c. "Property Damage" means: (1) Any physical injury to or destruction or loss of tangible property which occurs during the policy period, including the loss of use of such property resulting from such injury or destruction; or (2) Loss of use of tangible property which has not been physically injured or destroyed provided such loss is caused by an occurrence during the policy period. d. "Insured" means any person employed, appointed to a board, elected, hired or

3 3 of 5 allowed to assume a temporary or permanent position or office or any others authorized by the Georgia General Assembly to be an insured in or with the State of Georgia or any of its departments, bureaus, offices, agencies, authorities, boards. The election to accept coverage under this policy shall be exclusively determined by the organizations electing to purchase this coverage. e. "Automobile" means a land motor vehicle, or semi-tractor and trailer designed for travel on public roads, to include any machinery or apparatus attached thereto. f. "Occurrence" means every act of an insured, including any continuous or repeated exposure to the same or substantially same conditions, which results in bodily injury, property damage or personal injury, arising out of an insured's employment with the State of Georgia or any department thereof. In addition, regardless of whether there has been the same general condition, any series or sequence of personnel actions by one or more insured from one or more departments against an employee shall be deemed one occurrence. g. "Department" means each department, bureau, office, agency, authority or board electing coverage for its employees under this policy. h. "Economic Loss" shall mean monetary loss compensable in money damages under the laws of the State of Georgia or the United States of America. i. "State Employee" shall include full time or part time employees who are paid from the State's Personal Service Line Item Budget, Board Members of State agencies and authorities; State elected officials and employees. 5. Policy Reference: Insurance Policy issued by the State of Georgia, Self Insurance Trust fund, Department of Administrative Services. 6. Policy Period: July 1st through June 30th. Renewal is automatic each year on July Type of Policy: The insurance afforded by this policy applies only to occurrences or happenings or events on or after the inception date for the Blanket General Liability Agreement. This policy covers the following: PERSONAL INJURY, BODILY INJURY, PROPERTY DAMAGE, SICKNESS, DISEASE, DEATH or ECONOMIC LOSS caused by or resulting from error, omission, or negligence in the performance of duties within the scope of an insured's employment with a participating entity that has purchased coverage prior to the date of the occurrence. This policy will respond to any covered allegations in order to defend and pay damages for a State employee or an insured non-state employee when a claim or lawsuit is filed and is not covered by the "Georgia Tort Claims Act." This policy does not provide any coverage when a claim or lawsuit is filed in any State Court system

4 4 of 5 operated by any Government entity of the State of Georgia and is covered by the "Georgia Tort Claims Act." In consideration of the payment of the appropriate premium, and subject to all of the limitations as set forth in this policy, the Department of Administrative Services agrees to provide insurance coverage and to make payments with respect thereto out of the fund authorized by O.C.G.A. Section Application for Coverage: Including coverage for medical malpractice for Physicians, Dentists, Registered Nurse Practitioners, Nurse Midwife and Physician Assistants. Coverage is automatic when the individual employee or Board Member is appointed to a State Human Resources Administration covered position. 9. Territory: Policy covers occurrences anywhere in the world. 10. Limits of Liability: $1,000, each person, $3,000, aggregate occurrence. 11. Notice of Claim or Lawsuit: a. To make certain that covered employees or state entities do not prejudice their rights to protection under this policy, each employee or employing agency must report promptly, when: (1) Notice of a claim or lawsuit is delivered to the employee or employing agency; or (2) An arrest warrant, arising out of a job related occurrence, is served on the employee; or (3) A notice (written or oral) is received from any person indicating an intention to hold the employee responsible for any breach or duty; or (4) Any incident occurs that is likely to result in a claim or lawsuit. Early reporting of an incident and the circumstances involved may be crucial to the final outcome.

5 5 of 5 b. Incident Reporting: When either of the above occurs, IMMEDIATELY forward all available information, along with copies of claims, lawsuits or intent letters with a letter of explanation to: Risk Management Georgia Department of Human Services Office of Facilities & Support Services 2 Peachtree Street, NW, Suite Atlanta, Georgia Phone Number: (404) Fax Number: (770) Address: cdreid@dhr.state.ga.us This is a summary of the actual General Liability Agreement administered by the Georgia Department of Administrative Services. The full policy is also available.